Contract Pharmacy Details

THRIFTY WHITE PHARMACY #005
RRC350015-00 Sanford Bismarck

Covered Entity Details

Entity Name

Sanford Bismarck

Subdivision Name

Type

Rural Referral Center

340B ID

RRC350015-00

Entity Address

300 N 7th St
Bismarck, ND 58501

Medicare Provider Number

350015

Participating Start Date

1/1/2013

Last Recertification Date

8/21/2015

Entity Termination Date

7/1/2016

Pharmacy Details

Pharmacy Name

THRIFTY WHITE PHARMACY #005

Pharmacy Address

707 SOUTH 3RD ST
BISMARCK, ND 58504

Pharmacy Comments

Contract Details

Approval Date

1/25/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310

Contract Pharmacy Representative

THRIFTY WHITE
Alicia Hager, Pharmacy Operations Specialist
(763) 463-4482

Signed By Date

1/25/2016

340B Drug Pricing Program Database